Provider Demographics
NPI:1770861387
Name:WILLIS, CATHERINE YVONNE (LPC, LSOTP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:YVONNE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LPC, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2702
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76202-2702
Mailing Address - Country:US
Mailing Address - Phone:972-800-8814
Mailing Address - Fax:940-891-0525
Practice Address - Street 1:215 W MULBERRY ST
Practice Address - Street 2:STE. A
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-6061
Practice Address - Country:US
Practice Address - Phone:972-800-8814
Practice Address - Fax:840-891-0525
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16957101YP2500X
TX98967101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional